Basic Information
| Provider Information | |||||||||
| NPI: | 1720379779 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMPSON | ||||||||
| FirstName: | ETHEL | ||||||||
| MiddleName: | LEONA | ||||||||
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| Credential: | B.S. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SIMPSON | ||||||||
| OtherFirstName: | CHYNA | ||||||||
| OtherMiddleName: | LEONA | ||||||||
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| OtherCredential: | B.S. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2820 W CHARLESTON BLVD | ||||||||
| Address2: | C23 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891021942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024374673 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2820 W CHARLESTON BLVD | ||||||||
| Address2: | C23 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891021942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024374673 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2011 | ||||||||
| LastUpdateDate: | 04/26/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | NV | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.